The Impact of Infection Versus Colonization on <i>Clostridioides difficile</i> Environmental Contamination in Hospitalized Patients With Diarrhea

Warren, Bobby G; Turner, Nicholas; Addison, Rachel; Nelson, Alicia; Barrett, Aaron; Addison, Bechtler; Graves, Amanda; Smith, Becky; Lewis, Sarah S.; Weber, David J.; Sickbert-Bennett, Emily E.; Anderson, Deverick J.

doi:10.1093/ofid/ofac069

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…This suggests other potential sources of disease development in the hospital environment. Indeed, while asymptomatic carriers of C. difficile have not been a significant focus of infection prevention efforts, studies have shown that these carriers do shed toxigenic C. difficile spores to their surroundings, which could cause disease ( 14 ). Though carriers have not been consistently identified as major transmitters of C. difficile that causes CDI, recent work has suggested that patients carrying C. difficile asymptomatically may be at elevated risk for the development of CDI ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Genomic surveillance of Clostridioides difficile transmission and virulence in a healthcare setting

Newcomer,

Fishbein,

Zhang

et al. 2024

mBio

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Clostridioides difficile infection remains a leading cause of hospital-associated diarrhea, despite increased antibiotic stewardship and transmission prevention strategies. This suggests a changing genomic landscape of C. difficile . Our study provides insight into the nature of prevalent C. difficile strains in a hospital setting and transmission patterns among carriers. Longitudinal sampling of surfaces and patient stool revealed that both toxigenic and nontoxigenic strains of C. difficile clade 1 dominate these two wards. Moreover, quantification of transmission in carriers of these clade 1 isolates underscores the need to revisit infection prevention measures in this patient group. We identified unique genetic signatures associated with virulence in this clade. Our data highlight the complexities of preventing transmission of this pathogen in a hospital setting and the need to investigate the mechanisms of in vivo persistence and virulence of prevalent lineages in the host gut microbiome.

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Section: Introductionmentioning

confidence: 99%

Genomic surveillance of Clostridioides difficile transmission and virulence in a healthcare setting

Newcomer,

Fishbein,

Zhang

et al. 2024

mBio

View full text Add to dashboard Cite

show abstract

“…This suggests other potential sources of disease development in the hospital environment. Indeed, while asymptomatic carriers of C. difficile have not been a significant focus of infection prevention efforts, studies have shown these carriers do shed toxigenic C. difficile spores to their surroundings that could cause disease 14 . Though carriers have not been consistently identified as major transmitters of C. difficile that causes CDI, recent work has suggested that patients carrying C. difficile asymptomatically may be at elevated risk for development of CDI 15 .…”

Section: Introductionmentioning

confidence: 99%

“…This suggests other potential sources of pathogen exposure in the hospital environment. While asymptomatic carriers of C. difficile have not been a significant focus of infection prevention efforts, studies have shown these carriers do shed viable, toxigenic C. difficile to their surroundings that could cause disease 14 . Several studies have shown evidence of a reduction in CDI cases if asymptomatic carriers are put on similar contact precautions to CDI patients [15][16][17] , but this has not been consistently found 18 .…”

Section: Introductionmentioning

confidence: 99%

Genomic surveillance ofClostridioides difficiletransmission and virulence in a healthcare setting

Newcomer,

Fishbein,

Zhang

et al. 2023

Preprint

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Clostridioides difficileinfection (CDI) is a major cause of healthcare-associated diarrhea, despite the widespread implementation of contact precautions for patients with CDI. Here, we investigate strain contamination in a hospital setting and genomic determinants of disease outcomes. Across two wards over six months, we selectively culturedC. difficilefrom patients (n=384) and their environments. Whole-genome sequencing (WGS) of 146 isolates revealed that mostC. difficileisolates were from clade 1 (131/146, 89.7%), while only one isolate of the hypervirulent ST1 was recovered. Of culture-positive admissions, 17% of patients were diagnosed with CDI upon admission. We defined 29 strain networks at ≤ 2 core gene SNPs; 2 of these networks contain strains from different patients. Strain networks were temporally linked (p<0.0001). Across networks and over time, we found a minority of networks contained differences in phage populations. To understand genomic correlates of disease, we conducted WGS on an additional cohort ofC. difficile(n=102 isolates) from the same hospital and confirmed that clade 1 isolates are responsible for most CDI cases. We found that while toxigenicC. difficileisolates are associated with the presence ofcdtR, nontoxigenic isolates have an increased abundance of prophages. Our pangenomic analysis of clade 1 isolates suggests that while toxin genes (tcdABER and cdtR) were associated with CDI symptoms, they are dispensable for patient colonization. These data indicate toxigenic and nontoxigenicC. difficilecontamination persists in a hospital setting and highlight further investigation into how accessory genomic repertoires contribute toC. difficilecolonization and disease.

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An Enhanced Strategy for Daily Disinfection in Acute Care Hospital Rooms

et al. 2022

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ImportanceEnvironmental contamination is a source of transmission between patients, health care practitioners, and other stakeholders in the acute care setting.ObjectiveTo compare the efficacy of an enhanced daily disinfection strategy vs standard disinfection in acute care hospital rooms.Design, Setting, and ParticipantsThis randomized clinical trial (RCT) was conducted in acute care hospital rooms at Duke University Hospital in Durham, North Carolina, from November 2021 to March 2022. Rooms were occupied by patients with contact precautions. Room surfaces (bed rails, overbed table, and in-room sink) were divided into 2 sides (right vs left), allowing each room to serve as its own control. Each side was randomized 1:1 to the intervention group or control group.InterventionsThe intervention was a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe. It was applied in addition to routine disinfection for the intervention group. The control group received no intervention beyond routine disinfection.Main Outcomes and MeasuresThe primary outcome was the total contamination, measured in colony-forming units (CFUs) on the bed rails, overbed table, and sink on study day 1. The secondary outcomes were the proportion of sample areas with positive test results for clinically important pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and carbapenem-resistant Enterobacteriaceae; the similarity in baseline contamination between sample area sides on study day 0 before application of the intervention, and the proportion of sample areas with removed UV luminescent gel on study day 1.ResultsA total of 50 study rooms occupied by 50 unique patients (median [IQR] age, 61 [45-69] years; 26 men [52%]) with contact precautions were enrolled. Of these patients, 41 (82%) were actively receiving antibiotics, 39 (78%) were bedridden, and 28 (56%) had active infections with study-defined clinically important pathogens. On study day 1, the median (IQR) total CFUs for the intervention group was lower than that for the control group (3561 [1292-7602] CFUs vs 5219 [1540-12 364] CFUs; P = .002). On study day 1, the intervention side was less frequently contaminated with patient-associated clinically important pathogens compared with the control side of the room (4 [14%] vs 11 [39%]; P = .04).Conclusions and RelevanceResults of this RCT demonstrated that a quaternary ammonium, salt-based, 24-hour continuously active germicidal wipe decreased the environmental bioburden in acute care hospital rooms compared with routine disinfection. The findings warrant large-scale RCTs to determine whether enhanced daily disinfection strategies can decrease patient acquisition and adverse patient outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT05560321

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The Impact of Infection Versus Colonization on Clostridioides difficile Environmental Contamination in Hospitalized Patients With Diarrhea

Cited by 7 publications

References 19 publications

Genomic surveillance of Clostridioides difficile transmission and virulence in a healthcare setting

Genomic surveillance of Clostridioides difficile transmission and virulence in a healthcare setting

Genomic surveillance ofClostridioides difficiletransmission and virulence in a healthcare setting

An Enhanced Strategy for Daily Disinfection in Acute Care Hospital Rooms

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